Special features

Drug withdrawal — The most common problems

By Paul Davison, MSc, MRPharmS, Alan Worsley PhD, MRPharmS, and Andrew Husband MSc, MRPharmS

Withdrawal effects can occur when drugs acting on the central nervous system are discontinued, and may be mistaken for other diseases. This article describes the most common withdrawal effects seen in both secondary and primary care

This article as a PDF (50K)

Paul Davison and Alan Worsley are senior lecturers in pharmacy practice and Andrew Husband is principal lecturer in pharmacy practice, all at the University of Sunderland

Alfred Pasieka/SPL

Psychological dependence results from increased dopamine-mediated synaptic transmission throughout the “reward pathways” of the brain

SUMMARY

When a drug that acts on the central nervous system needs to be withdrawn it should be done carefully. Patients may wish to stop using illicit drugs or may need to withdraw from prescribed therapy upon which they have become dependant.

Other situations in which drugs may need to be withdrawn include changing treatment after a suboptimal response (eg, switching between antidepressant drugs) or after the patient has experienced an adverse drug reaction.

There are also numerous situations in which routine therapy needs to be changed due to factors such as pregnancy or the need to undergo elective surgery.

Withdrawing medicines can be complex and the method used is influenced by the reason for withdrawal.

For example, the decision of whether to continue routine drug therapy in patients undergoing surgery is influenced by the indication for treatment, the type of anaesthesia to be used and the nature of the surgery (see p370). The increasing age of the population and the prevalence of chronic disease states means that pharmacological management of surgical patients is becoming an increasingly complex problem.

Appropriate management of drug withdrawal is essential to ensure that the therapy is optimal and safe. Pharmacists’ input is an essential part of the treatment decision.

This article will describe the psychological and physiological mechanisms that cause problems in drug withdrawal.

The second part of this feature (p367) will described the techniques used to withdraw drugs that commonly cause problems, and the management of drug withdrawal in special patient groups.

Full text article PDF (50K)

Panel 1: Symptoms of benzodiazepine withdrawal

Symptoms of benzodiazepine withdrawal can be classified as mild or severe.

Severe symptoms include:
• Muscle twitches
• Seizures
• Tachycardia
• Confusion
• Panic attacks.

Mild symptoms include:
• Insomnia
• Dizziness
• Headache
• Anxiety
• Hypersensitivity to light or sound